15713 " . POST THI' RD NEAR FRONT OF,BUILDING
Cl
'OF CUPERTINO PERMIT NUMBER
INSPECTION DIVISION
JOB INSPECTION.RECORD
I <( a�
s '
- PERMIY""�
• E XPI RATION
.JOB ADDRESS 0(1 NOd LF-C UNIT# _LOT#-
• PERMIT EXPIRESAF WORK
OWNER CONTRACTOR • - IS NOT STARTED'WITHIN -
INSPECTION DATE INSPECTOR INSPECTION RECORD 780 DAYS OF PERMIT ISSU.
FOUNDATIONANCE OR;180 DAYS FROM
_ NOTE: ^ '' LAST CALLED INSPECTION.
LIFER - ALL GRADING AND DRAINAGE SHALL BE INSTALLED
' PREGUNITE ,TO COMPLY WITH THE APPROVED-'PLANS AND CITY OF
CUPERTINO STANDARDS .P[Rn+IT VALIDATIONa,
.'; , '
GARAGE SLABS - -
POUR NO CONCRETE UNTIL ABOVE HAS BEEN SIGNED
UNDERGROUND
/SLAB
w PLUMBING - r •/, ,+ a"w;
c A.
ELECTRICAL. 4 - ISSUANCE DATE -
MECHANICAL .BLOG. ELECT. " PLG.. MECH.
,:0 : `0 0'
DO NOT POUR FLOOR UNTIL ABOVE HAS BEEN SIGNED 1(3 UILDING PERMIT
' '.WOOD FLOOR ;' .`. �P 3.
INFORMATION'
PLUMBING - v_�A�^}�'UATION .• S/FT I
MECHANICAL _ - Clty B�' fo- � 4 j
-, ELECTRICAL
FRAMING Al' y � � IEd;✓,E
INSULATION .. STORIES PE CONSTR.
/a L OCC GROUP WES.UNITS
PLACE NO SUBFLOOR UNTIL ABOVE HAS BEEN SIGNED -7-
'SO,IT,FLOOR AREA -TOTAL ACREAGE
- - 'ROOF NOTE:NO FINAL'NSP SHALL'BE MADE BEFORE - _ '
DIAPHRAGM THE CONSTRUCTION TAXIS PAID
ROOF SHEATHING - II '
RES 'Rvuu'LoCON sEPB o
APPLY NO ROOFING UNTIL ABOVE HAS BEEN SIGNED FINALS DATE INSP. ❑ ❑ ❑ - ❑ 1:1
_ , A55LS50HS PARCEL NC.
ROUGH' SAN.p
PLUMBING ELECT.ENERGY - - - `
TUBS 8 SHOWER PAN -
TRACT NO,_, PARCEL NO
'PLUMBING ENERGY ( , I' ,
MECHANICAL- MECH.ENERGY
I• ELECTRICAL BUILDING ENERGY, M1 ACC DATE j AGC.FILE.NO
FRAMING ' i ELECT.'FINALTEST 'y� '
b INSULATION , PLUMBING - ZONING •ENG.SITE NO.
• GAS TEST _ .'. GAS ^
FIRE SPRINK ENERGY T-j9
MECHANICAL (•
COVER NO WORK UNTIL ABOVE HAS BEEN SIGNED HEATING `❑ ( IN[] V ❑' "❑'
I' • FLOOD ZONE, A,L U.C.
EXTERIOR SHEAR ELECTRICAL RELEASE 441
INTERIOR SHEAR FIRE DEPT.,
`'+❑• "❑ Y ❑ •:".❑'
SHEETROCK - GRADE' �.` FEE SUMMARY
.. EXTERIOR LATH IBUILDING , .--
-
INTERIOR, LATH ! - _ TEMPORARY APPROVAL 'eUILDING. +
�.
•SCRATCH COAT - ELECTRIC - PLAN CHECK I '
.. . GAS - FEE , -
NO TAPE OR PLASTER UNTIL ABOVE HAS BEEN SIGNED JOCCUPANCY - SEISMIC FEE 7
' OCCUPANCY OF BUILDING IS NOTPERMITTEDUNTIL BUILDING FINAL ISSIGNED BY BUILDING INSPECTOR. MICROFILMLU
AR RANG E.FOR INSPECTION BY PHONING 252-4505, �EtECTRIc'.
ONE-WORKING DAY BEFORE REQUIRED INSPECTION.' PLUMBING
0'� .PLEASE GIVE JOB ADDRESS WHEN IPHONING.'I* Z
1 — SEE PERMIT FOR EXPIRATION DATE — MECHANICAL
IMPORTANT! ` ',CONST,TAX
PLEASE READ.REVERSE SIDE BEFORE:
CALLING FOR FINAL INSPECTION. TOTAL
OFFICE COPY
APPLICANT TO FILL IN INF., ATION,WITHIN RED LINES= USE I LL POINT PEN ONLY,
r
.BUI.BUI LD�CT'I DENTI FIC I ` f ' "e + PERMIT NUMBER
"' APPLICATION & PE IT
DING ,'r.KOLFL p RESS. '� Pl'�i CuPERTrNo`` i�� ✓9 Q 4iBUILDING —ELECTRICAL PLUMBING-MECHANICALER$ ESE- NCOpPINq' CT�• 4 PLAN CHECK VALIDATION
E IrIL
19 dui k, Y TY. ELECTRIC PERMIT FEE
. } CONTRACTOR 5 4
rvAME „ �- tI �5' , '7 OUTLETS`SWITCHES`-RECEP 10.60/1.00 -
f ' uc.NO• LIGHTING'FIXTURES-;' ` 10.00/1,00
Y CONTRACTORS
ADDRESS J �+ +. ' APPLIANCES-RESIDENTIAL,;. ,4.00 ,1
' PHONE .,PANELS-—" : - ' 1000 :DATEOF APPLICATION- `
ARCHITECT ,` --- - AN. - - P.C. O.
aA X
OR ?Ack.1044S 1WO_6lAT4rS+ J PANELS IOVER'200AMP1 20.00 PL
'I i,,,.CHECK FEEf.f.
uaNO, (a'L
SIGNSTRAINS. •- °;� 3.00 .-y' ;A�t - - z Ili
ARCH.OR
,1ENG 8 SPECIAL CIRCUI-Ta; :' 5 00 _ ;PERMIT VALIDATION
a°gEss �7x LAU '.
sc
AI. A cizWz CA" ZiP,1OS .EMP.METER OR POLE INS. K .."..20.00,
aPPurs 'F
cArv „ -- SEEEE SCH.
Ka AODRE55, 3815 'rNQP qQp. RO..it 395 .'.. MoroRs ' ,�
< - . .LEAS N O " .0 SERVICECHANGE '.=2000 e I t
,Foo, "LICENSEDCO RACTORS DF,CLARATION w.' 1.
Z w " I hereby:affum that I:amrlr Bused under provisions of Chapter 9 TE .:
((commencing ISSUANCE GA
g with Section'7000)-of Division 3 of,the Business and Ir BLDG.` ELECT,C PLG MECH
F zn Professions Cod and my license is in full force and effect: 1
¢ o°' — LmenSe Class "c' 'a LIc.Number
+ 4 z H wa'+ Dale -IContmctot
¢ a, w a " „�.i- OWNER-BUILDER DECLARATION I -
BUILDING PERMIT
X ; �- . - - NFORMATION
a- w 1 hereby atf r that,l'am'exempt from'the Contractor's License MISC — REFER TO OR
u o¢ Law for the following reason.(Sec 7031 5,Business and Professmns -' UATION (
_ u,J PERMIT ISSUANCE 1000 (`i1y- ,
i,viLoop:to, y city or county
repair ny str requires ure,p sort to construct,
uance,also
,aate a:¢ �' improve;demolish ortepair any structure,poor to its Issuance,also', ELECT.CONTR r� E -LIC NO.- - ,w ELEC
O rc., requires the applicant for such permit to file a'signed statement that .."' TOTAL -
he Is licensed pursuat l0 nthe provisions of the Contractors License � - F'PERMIT TO
.F,zQ
Law(Chapter 9(oommencing with Section 7000)ofDlvlsion 3 ofthe - "s-•."- - - n ! '!.(/TEQ/O.,'i,
4 m o Business and Probssions Code)or that he is xempt'therefroand' CITY. PLUMBING PERMIT,, ''FEE VC.
SC H m the basis for the alleged exemption.Any.violat fSection 7031.5 I�' ,. STORIES TYPE CONSTR.
n 3 _ by any applicant for a permit subjects the applicant to a civil penalty a -
ALTER-DRAIN.&VENT-WATER (EA.):500 ^• �'
of not more owner
Usethe pred'dollars(my amp - .. _ '
❑
b; DEVICE owner of the property,or my employees with wages ash ' BACK FLOWPROTECT.DEV ICE" 4A0
their sole.compensatlon,will,do the.work,and the structure Rs not - '."1.. !,OCC.GROUP RES UNITS
+:y intended or'ofGnc&for sale,(Sec. 7044;Business and Professions' DRAINS-FLOOR,ROOF;AR EA;CON D. 5 00 "
Code:The Contractors License.Law docs not apply.t0 an owner of 'r %� + +° "
property who bmlds or improves thereon,and who does such work FIXTURES:,PER TRAP' ,
himself or through his own employees,provided that such improve- -a 00 5°.FT,FLOOR AREA TOTAL ACREAGE`.
I ments are,not intended.or offered for,sale.If,however,the budding. , GAS-EA'.SVSTEM-11NC 40UTLETS 600
••l or improvement Is sold within one.year.of completion,thelown•t-
builder will have the burden of proving that he did not builif.,Ito- GAS-EA.SYSTEM-OVER.4.(EA.) ZOO A'` - - BUILDING USE
p ve,for purpose of sale.). -;+, I a RES�r"^IND • CON ,- PB' Other
INDUSTRIAL WASTE INTER 3000 i -
tpJ�� 1,as owned of,the-properly am exclusively contracting with`^ -
lifensed c'Onlr etmrs to constrw.t the project(Sec. 7044,Business ,, LAWN.SP.R IN KLERS-'1 INC 5 V B.�.1• 6.00 ASSESSORS PARCEL No
and Professions Code:The Contractor's License Law does not apply - - C'
to an owner of property who builds or'improves thereon.and who ' LAWN SPRINKLERS'=OVER'5'(EA.) 1.00
contracts for such projects with a contractors)licensed pursuant to
I, the Contractor's License Law. _ SEWER-SANITARY-STORM_ EA:2.00ft/10.00 y ; . TRACT NO: . -PARCEL NO.
❑ '1 am exempt,under Sec. B.&P.C.I or this ✓ s'
reason .WATERHEATER W/VENT ",7r 600 .%' ,.v. - -
' Uate`e' ' � WATER SYSTEM 500 .ACC.vDATE ,'ACC FILE NO:`'1
WORKERS'C MPENSATION.DECLARATION WATER TREATING.EQUIP '?;':. 5.00
I hereby afTmm,thaFI have a certificate'of omsent to self-insure - ✓' '
Or a certificate Of Workers'Compensation Insurance,or a cerflied - +.' C "IZONING „ ENG SITE NO'-
pY hereoP(Sec 3800,Lab C.)'
Policy.NoCompany
1 '" 0 ❑ CcH Pied OpY is hereby furnished -
Z}Z, ❑ Certified copy'i, filed with the 'ity npectiun division.
FIRE SPRINK *ENERGY T2A
0' Applicant + MISC.- V REFER'TO ORD ,Y.❑+ NO. ,>v,❑' NO
PERMIT ISSUANCE �',y'^ , 1000 - - -
CERTIFICATEOF EXEMPTION FROM WORKERS' r- p ' FLOOD ZONEAL.U.C.
, COMPENSATION INSURANCE n� PLG.CONTR. ,LIC.NO. PLG,-
CL
LG
-,d"E' ,.1ThIs Sectidn need,no[,be completed'.if the permit is for one 3+ - ' 1 ' TOTAL p: Y❑ ,N I� .. Y,E], NE]
0'2;' hundred dollars(1100)of less) . , a .
.U'0'• ; 1-certify,that in the perf.Trimee'of the work for which this per- CITY.' MECHANICAL PERMIT FEE ' FEE SUMMARY '
1 LLQF mit Is¢sued,1 shalllnot employ any person In any manner so as to !', -
0w become"subject to the Workers Compensation Laws of California.
m. Date'- ` - ApplicantA LTER OR ADD TO�MECH,-a 15.00 f a- 1' s, BUILDINGy
NOTICE TO`APPLICANT: If,after making this Certificate oOLx-; -
�.Z ,i emption;you should become subject to the Workers'Compensation APPLIANCE.a+ 5.00 �.'A`, ,PLAN CHECK.. '
I provisions ofrthe Cabot Code, you most forthwith comply with - • FEE' •+
.U: such provisions or this'permit shall be deemed revoked. AIR HANDLING UNIT(TO 1Q000C.F.M.). 4.00 _ �/ _
F 'AIR HANDLING UNIT(OVER IO,000C.FM.) 6.00 ' ISEISMIC FEE �" ' T 7
". CONSTRUCTION LENDING AGENCY - �"
I here by�afOrm thaC there is a coinstiuction lend ng agency for EXHAUST HOOD(WITH DUCT) 5.00
'p 't the performance of the work for which this permit is Issued(Sec., - ;,MICROFILM ,
T 3097,civic.), _ HE_ATING'UNIT(TO 100,00_0 B.T.U'.L_ 8.00
+ Lernicna Name a
Lender's Address I " HEATING UNITIOVER,100,000B.T.U)9.50 ELECTRIC.. I
( Icertify that l have read this application and state That the above VENTI LATIOWFAN.(SI NG LE) ",` i4.00
InInformation is correct. 1 agree to comply with all City and county BOILER-COMM H.P.or.100,D006.T.U.) 600 - PLl1MBING 'r,,1>
Y ordinances and state'laws-relating"t0 building construction, and
j, hereby authorize representatives of.this city to enter upon the BOILER-COMP IGVa[100,000'BTUI,BEE FEE SCH - I :
v above-mentioned property forinspection purposes r,-q _ - r, 'MECHANICAL
._ n'. ,We t1'.
ee to'save�"indemnif 'and keep MI _
( ),i y ocp hannleas the City of SC.- REFER TO ORD. - a
- d ay in
way accailities, st Saidjudgments,City
in and expenses whihe -'CONST.TAX
k ay..in,any,way'accrue against said City in consoyuence.,of the ' PERMIT ISSUANCE_- - :yf 1000 s - . a '
yQri�}ntingoftlys,PermrlC Y t MECH.CONT LIC.NO. - MECH
' T R! TOTAL I �'< l
TOTAL ,
gnature of Applicant/ nlr tot Dale I+
;g
, OFFICE COPd. ' a'